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Diabetes and Pregnancy - What is Gestational Diabetes?

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Gestational Diabetes

By Nina Nazor

Have you or someone you love been recently diagnosed with gestational diabetes? You must be worried, but relax, it can be controlled with a healthy diet, exercise and insulin if needed.

Gestational diabetes is the type of diabetes mellitus that is first detected during pregnancy, usually between week 24 and 28 of gestation. If you have gestational diabetes, your baby does not have diabetes, however, you must keep your blood glucose levels under control to avoid health problems for you or your baby. Gestational diabetes affects about 4% of all pregnant women in the United States each year.

What are the causes of gestational diabetes?

The causes of gestational diabetes are not understood in detail, but it seems like the placenta produces a hormone called placental lactogen, which is thought to inactivate up to 50% of insulin action in your body. This makes it more difficult for your cells to use insulin and glucose cannot enter the cells of your body to be stored or converted into energy and it then can build up in your blood to very high levels.

When the baby is born and the placenta is out of your body, it is very likely that your blood glucose levels return to normal, but once you've had gestational diabetes, your chance of developing gestational diabetes in future pregnancies is increased, as it is the risk of having type 2 diabetes.

In the case your blood glucose levels don't get back to normal after having your baby, then you must have had diabetes before the pregnancy or developed type 1 or type 2 during the pregnancy. Then you would need to have diabetes treatment for good.

You should have a glucose test 6 weeks after delivery to make sure your glucose levels are in normal levels.

How does gestational diabetes affect you and your baby?

Your baby does not have diabetes. He is healthy and comfortable in your womb, but if you don't control glucose levels, the baby can get hurt.

When your blood glucose levels are high, the baby receives that excess glucose and produces more and more insulin to use it or store it as fat. This can make your baby very big, what is called macrosomia.

If the baby is too big there be problems like damaged shoulders or another trauma related with a difficult birth.

Also, the baby can develop dangerous low glucose levels after he is separated from you. Since he is used to get high levels of glucose through the umbilical cord, his little body is used to release too much insulin, and that causes hypoglycemia after birth.

Another problem the baby might have could be breathing difficulty because his lungs may not develop completely due to high glucose levels in your blood.

You can be at greater risk for hypertension, preclampsia and C.section, but remember, if you keep glucose under control and follow a heathy diet, exercise regularly and do what your Diabetes Care Team tells you to do, you will have a successful pregnancy and your baby will be healthy.

How is gestational diabetes diagnosed?

The test for diagnose has two components. First, the people at the lab would give you a drink containing 50g of glucose. Then, after 1 hour, they would take another sample of your blood and test it. If you have above 140 mg/dL they will ask you to come back other day to have a glucose tolerance test

In this test, they will take a fasting blood sample, give you a drink with 100g of glucose and take samples again at 30 minutes, 1 hour, 2 hours and 3 hours.

The diagnosis is positive for gestational diabetes if you have any two of the following values: a fasting plasma glucose above 105 mg/dl, a 1-hour glucose above than 190 mg/dl, a 2-hour glucose level above 165 mg/dl, or a 3-hour glucose concentration of more than 145 mg/dl.

Treating gestational diabetes

Treatment has to be started immediately. Your health team might even ask you to stay at the hospital to be monitored. For sure you will need to have a meal plan designed for you, an exercise plan, daily blood glucose monitoring and insulin shots if your blood glucose levels don't respond well to diet and exercise.

The use of diabetes pills during pregnancy is not recommended since they cross the placenta reaching the baby. Insulin works only in your body helping keep your blood glucose levels under control but without crossing the placenta and thus, not affecting the baby.

Following the treatment correctly will allow you to have a healthy pregnancy and birth, protecting your baby.

After pregnancy

You have an increased risk for developing diabetes in the future, so you should try to follow a healthy lifestyle, lose weight, exercise regularly, eat a well balanced diet and stay fit.

Adapted from the American Diabetes Association: Gestational Diabetes Information.

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